应用多普勒超声定量分析正常中晚孕期胎儿左心室收缩舒张时间指数  

Measurement of left ventricular systolic to diastolic time index in normal fetuses in the second and third trimesters using both spectral and tissue Doppler echocardiography

作　　者：赵红娟 赵博文[1] 潘美[1] 纪园园 彭晓慧[1] 陈冉[1] Zhao Hongjuan;Zhao Bowen;Pan Mei;Ji Yuanyuan;Peng Xiaohui;Chen Ran(Department of Diagnostic Ultrasound&Echocardiography,Sir Run-Run Shaw Hospital,Zhejiang University College of Medicine,Technical Guidance Center for Fetal Echocardiography of Zhejiang Province&Sir Run-Run Shaw Institute of Clinical Medicine of Zhejiang University,Hangzhou 310016,China;Department of Ultrasound,Lin'an District First People's Hospital,Hangzhou 311300,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院超声科、浙江省胎儿心脏超声诊断技术指导中心、浙江大学邵逸夫临床医学研究所,杭州310016 [2]浙江省杭州市临安区第一人民医院超声科,杭州311300

出　　处：《中华医学超声杂志（电子版）》2023年第9期951-958,共8页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：浙江大学科学技术研究院一般横向项目(校合-2021-KYY-518053-0055);浙江省基础公益研究计划项目(LGF20H180013)。

摘　　要：目的建立中晚孕期胎儿左心室收缩舒张时间指数(SDI)的正常值参考范围,并探讨胎儿孕周、胎心率对SDI的影响以及应用SDI评估胎儿心功能的可行性。方法采用脉冲多普勒(PD)和组织多普勒(TDI)对2021年9月至2022年2月在浙江大学医学院附属邵逸夫医院超声科进行胎儿超声心动图检查的408例正常中晚孕期(18~38周)单胎儿左心室功能指标进行测量。应用PD法/TDI法分别获得胎儿左心的等容收缩时间(ICT/ICT')、等容舒张时间(IRT/IRT')、充盈时间(FT/FT')和射血时间(ET/ET')4个胎儿心脏时间间期,并通过公式计算胎儿左心的SDI/SDI'及心肌做功指数(MPI/MPI')。获得SDI和SDI'正常值参考范围,采用配对t检验分析PD法和TDI法分别测得的SDI与SDI'的差异,对SDI、SDI'与孕周、胎心率之间进行直线相关(Pearson)分析,采用多因素线性回归分析舒张功能指标E/A、E'/A'、E/E'以及整体心功能指标MPI和MPI'对SDI及SDI'的影响。采用组内相关系数(ICC)评估4个时间间期的测量者内和测量者间重复性。结果PD法测得SDI正常值为1.380±0.141;TDI法测得SDI'正常值为1.499±0.167,2种方法测得的SDI、SDI'值间差异具有统计学意义(t=-13.55,P<0.001)。直线相关分析显示SDI与孕周呈负相关(r=-0.267,P<0.001),SDI'与孕周呈负相关(r=-0.179,P<0.001),均随孕周增加略有下降;SDI与胎心率呈正相关(r=0.324,P<0.001),SDI'与胎心率呈正相关(r=0.290,P<0.001)。多因素线性回归分析结果显示,E/A、E/E'、MPI的变化对SDI的影响存在统计学意义;E'/A'、MPI'的变化对SDI'的影响存在统计学意义。重复性检验结果显示2种多普勒超声测得的4个时间间期的测量者内和测量者间组内相关系数值均>0.75,表示信度良好、可重复性高。结论通过PD与TDI定量测量并建立了中晚孕期正常胎儿左心室SDI、SDI'的正常值参考范围,TDI测值高于PD测值,测量简便易行,均可为临床监测正常胎儿时间间期�Objective To establish the normal reference range of left ventricular systolic to diastolic time index(SDI)in normal fetuses in the second and third trimesters by using both spectral and tissue Doppler echocardiography,to assess the effect of fetal gestational age(GA)and fetal heart rate(FHR)on SDI,and to explore the feasibility of using SDI to evaluate fetal left ventricular function.Methods The left ventricular time intervals were obtained in 408 singleton fetuses between 18 to 38 weeks of gestation by using pulse wave Doppler(PD)and tissue Doppler imaging(TDI)at the Department of Ultrasonography of Run Run Shaw Hospital,Zhejiang University School of Medicine.SDI and SDI'were then calculated.Isovolumetric contraction time(ICT/ICT'),isovolumetric relaxation time(IRT/IRT'),filling time(FT/FT'),and ejection time(ET/ET')of the fetal left ventricle were obtained by PD and TDI,respectively.Left ventricular SDI,SDI',and myocardial performance index(MPI/MPI')were calculated subsequently.Normal reference range values of SDI and SDI'were obtained,and paired t-test was used to analyze the differences between the SDI and SDI'values measured by PD and TDI,respectively.The correlation between SDI/SDI'and the independent variables GA and FHR was analyzed by linear correlation(Pearson)analysis,and multivariate linear regression was used to analyze the effects of SDI and SDI'on diastolic function indexes(E/A,E'/A',and E/E')and the indicator of overall cardiac function(MPI/MPI').Intra-and inter-measurement reproducibility was assessed using the intra-group correlation coefficient(ICC).Results The normal reference range of SDI was 1.380±0.141 and that of SDI'was 1.499±0.167;paired t-test analysis showed a statistical difference between the SDI and SDI'values measured by PD and TDI,respectively(t=-13.55,P<0.001).Line correlation analysis showed a negative correlation between SDI and GA(r=-0.267,P<0.001),and SDI'decreased with the increase of GA(r=-0.179,P<0.001).SDI was positively correlated with FHR(r=0.324,P<0.001),and SDI'was

关 键 词：胎儿 超声心动图 收缩舒张时间指数 时间间期 心功能 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.5[医药卫生—诊断学]